Healthcare Provider Details

I. General information

NPI: 1295732808
Provider Name (Legal Business Name): HYO-JONG PARK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2005
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 W HORIZON RIDGE PKWY
HENDERSON NV
89052-2648
US

IV. Provider business mailing address

2460 W HORIZON RIDGE PKWY
HENDERSON NV
89052-2648
US

V. Phone/Fax

Practice location:
  • Phone: 702-822-2000
  • Fax: 702-938-2237
Mailing address:
  • Phone: 702-822-2000
  • Fax: 702-938-2237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number5705
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: